[We have developed] a global curriculum [that] may be considered as a foundational scaffolding for training surgical oncologists worldwide.— Chandrakanth Are, MBBS, MBA, FRCS, FACS, and colleagues
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As reported by Chandrakanth Are, MBBS, MBA, FRCS, FACS, of the University of Nebraska Medical Center, Omaha, and colleagues at the Society of Surgical Oncology (SSO) and European Society of Surgical Oncology (ESSO), the rising global burden of cancer and inequalities in surgical oncology education and training among nations call for development of a global curriculum in surgical oncology. A proposal for such a curriculum was published jointly in Annals of Surgical Oncology and the European Journal of Surgical Oncology.1-4
Study of Training Paradigms
The investigators performed a study to identify regional training paradigms, which included 174 of 211 countries worldwide. Data were analyzed and categorized on the basis of the six World Health Organization (WHO) geographic regions and economic standing stratified by the Human Development Index.1,2 The primary findings of the study follow:
- Surgical oncology training is extremely long.
- The total training length in years (all years of education including premedical education, medical school, residency or postgraduate surgical training, and fellowship training) is extremely variable and can range from 8 to > 17 years.
- There is extreme variability in the length of residency or postgraduate surgical training.
- There is extreme variability in the length of surgical oncology fellowship training.
- In general, the length of training seems to be correlated with rising economic standing based on the Human Development Index.
- Not all countries have the capability to offer domestic surgical oncology fellowship training, particularly those in lower socioeconomic strata; the likelihood of availability of domestic surgical oncology fellowship training is correlated with rising economic standing based on the Human Development Index.
- Several countries that do not offer domestic surgical oncology fellowships still consider such training a requirement, and physicians from such countries often travel to a wide variety of foreign countries to obtain required training. There is wide variability in the location of foreign countries physicians travel to obtain the required training.
- There are no structured pathways to integrate the knowledge acquired abroad into the native systems once the physician returns home.
- In addition to variability among the six WHO geographic regions, extreme variations in training paradigms were found among countries within each region.
- There appear to be no uniform standards in the educational paradigms to train surgical oncologists among the six WHO geographic regions, within each region, or among countries of different economic standing based on the Human Development Index.
Proposed Global Curriculum
In response to these and other findings, the leaders of SSO and ESSO outlined a framework for a global curriculum in surgical oncology education and training that contains the following primary elements3,4:
Core Domains of General Oncology for the Surgical Oncologist
Knowledge and understanding of the principles of epidemiology of cancer; screening for cancer; chemotherapy; radiation therapy; biologic therapy and immunotherapy; chronic pain management; palliative care; medical imaging; multidisciplinary care; diagnostic pathology; surveillance; cancer biology; research; delivering care across all resource settings; and hereditary cancer syndromes.
Essentials of Core Knowledge Domains of Surgical Oncology for Each Specific Disease Site
Knowledge and understanding of the principles of management of malignancies involving breast; colorectal/anal cancer; esophagus, gastric/gastroesophageal junction; small intestine; pancreas; liver and biliary tract; endocrine; cutaneous oncology; sarcoma; peritoneal surface; thoracic; genitourinary; gynecology; and pathology applied to each disease-specific site.
Core Domains in Pre-, Peri-, and Postoperative Surgical Care for the Surgical
Oncologist
Knowledge and understanding of the principles of surgical procedures and techniques; various surgical approaches; patient selection; risk stratification prior to surgery; operative planning based on imaging/staging; obtaining consent for operative procedures; intraoperative care; postoperative care; and postoperative critical care.
Essential Training in Core Competencies
To attain competency in holistic patient care; medical knowledge; professionalism; interprofessional and communication skills; experiential learning; systems-based practice; operative skills; and understanding of the human/compassionate side of medicine.
The obligation to confront what was learned from this study falls on every individual within every surgical oncology organization, and no one can serve this role better than those societies that possess the needed academic and financial resources.— Daniel G. Coit, MD
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The authors concluded: “[We have developed] a global curriculum [that] may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment.”
In a statement released when the findings and proposal were published, SSO President Daniel G. Coit, MD, remarked, “The obligation to confront what was learned from this study falls on every individual within every surgical oncology organization, and no one can serve this role better than those societies that possess the needed academic and financial resources.” Dr. Coit is Attending Surgeon, Memorial Sloan Kettering Cancer Center, and Professor of Surgery, Weill Cornell Medical College. ■
Disclosure: Drs. Are and Coit reported no potential conflicts of interest.
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